LAUSR

There is no universally accepted treatment for severe pediatric alopecia areata (AA). This prospective study comprised 73 patients (aged 1–18 years) with severe AA (>30% of scalp surface area): 37 received 1‐day intravenous dexamethasone pulses (1‐DP) and 36 received 3‐day pulses (3‐DP), monthly, for 6–12 months. Also, all patients applied topical clobetasol propionate under plastic wrap occlusion. Patients achieving >50% regrowth were considered good responders (GR). All patients reached short term, while 65/73 were available for the long‐term follow‐up (mean 33.3 ± 15.3 vs. 27.7 ± 14.3 months, 1‐DP and 3‐DP, respectively). Relapses during therapy were more frequent in 1‐DP group. 3‐DP patients were more frequently GR in comparison with 1‐DP. 3‐DP patients with disease duration <6 months had better outcomes. Patients without Hashimoto thyroiditis (HT) had 9.8‐fold higher chance of being GR in comparison with HT patients. The best results were achieved in AA plurifocalis (AAP). No patient had severe short‐term side‐effects. At the long‐term follow‐up, 67% of 3‐DP patients had stable results. Only 14.2% AAP patients experienced relapses. Patients had no long‐term side‐effects. 3‐DP were more efficacious than 1‐DP. Short disease duration and no HT were good prognostic factors. 3‐DP protocol is well‐tolerated, with beneficial effects and long‐lasting results in severe pediatric AA.